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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) <br /> APPLICATION FOR LAND U PERMITS 3 <br /> E . <br /> e�►�z� blS�81o6�8a � Q <br /> OWNER F a�.tl I 1�w1 TELEPHONE — jt—"77�1�' o (� <br /> MAILING ADDRESSMAIS5t/a f <br /> PROPERTY ADDRESS F; e * 47(089 ' aJfrA A <br /> J e v <br /> LEGAL DESCRIPTION(see tax receipt) PCL ('roy Loi' S 4 <br /> /A 0 <br /> ❑ n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION D �. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 0,101 /J o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m � \ <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O w 41 <br /> iO N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> In Cl <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Zn � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. G1 Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS � <br /> MUST BE SIGNED AND DATED BY THE OWNER. Z' D —i <br /> to f ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CA W <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYQ <br /> PERMITTED. \ 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. LY <br /> 5. <br /> 6. M c: > M > -0 <br /> m F3 c, OD <br /> a o CD 0 <br /> 7. Z c m o 1 <br /> m < M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my — — : D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Cn : O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am W oO : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m m <br /> 0 <br /> authorized perso have access to the abov described premises at any reasonab � <br /> i n ? <br /> SIGN HERE m D <br /> n <br /> vi n <br /> (signat a owne r ilding contractor) (date) 0 <br /> ZONING ADMINISTRATOR j / APR 2 2 2005 <br /> ,4-1a-90 � # %/�9� (�, N <br /> O SHIP PE TS MAY BE REQUIRED x ON0Cn <br /> (JNO <br /> cn cn o <br /> THIS PERMIT HALL EXPIRE,ONE YEAR FROM TE OF ISSUlAgNG(fd/rl <br /> WM,-l- 4 It-t--Kr fYw;led & S-leve+-b(a+hL, OS6 <br />